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t- PPLICATIQN - LOT bNE-ADJUSTMENT <br /> y� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT _ <br /> w: :< <br /> FILE NUMBER: <br /> 'P <br /> FOR•' <br /> PROPOSED PARCELS <br /> Parcel Number Existing or Proposed Use of Parcel Existing Square Proposed Square <br /> Foota a or Acrea a Footage or Acreage <br /> N z_ �L.od lac�(97S <br /> oil— Ielo - a7_ ., <br /> SITE IMPROVEMENTS AND SERVICES <br /> Water <br /> Public WaterAnnex-Formation Distance to Public <br /> Service Provider Re uired Water Feet <br /> Proposed❑ <br /> Existing ❑ <br /> Private Waterg] Existing Well ® New Well ❑ Well Replacement ❑ <br /> Sewage Disposal <br /> Public Sewage Annex-Formation Distance to Public <br /> Disposal Service Provider Required Sewer Facility <br /> Proposed❑ <br /> Exi ting ❑ <br /> On-site Sewage <br /> Disposal Existing Septic System New Septic System ❑ Other ❑ <br /> Storm Drainage <br /> Public Storm <br /> Drainage Service Provider(if Public) Annex-Formation Terminal Drainage Detention-Retention <br /> Proposed❑ Required to: Ponds <br /> Existing❑ <br /> Private Storm <br /> Draina e❑ On-site Retention Pond s ❑ Natural Drainage/No Change Other ❑ <br /> Electricity Telephone Service <br /> Distance to <br /> Service Provider Service Service Provider Distance to Service <br /> }P —r jeo v <br /> School Service Fire Protection Service <br /> Distance to Elem <br /> Service Provider School Servicce Provider Distance to Fire Station <br /> Lbol <br /> Existin Roads <br /> Road/Street Name R.O.W.Width Pavement Width Curb/Gutter Sidewalks <br /> -TK T,4LFk 'p CpD t Z } Yes ❑ No® Yes❑ No <br /> Yes❑ No❑ Yes❑ No❑ <br /> Proposed Roads <br /> Road/Street Name R.O.W-Width . Pavement Width Curb/Gutter Sidewalks <br /> Yes ❑ No❑ Yes ❑ No <br /> Yes ❑ No ❑ Yes ❑ Non <br /> ROEVSMPlanoing Application Forms\ Page 4 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-3-03) <br />